Physicians Immediate Care - Urgent Care Centers

Notice of Privacy Practices for Personal Health Information HIPAA

Your privacy is as important to us as it is to you. Rest assured that Physicians Immediate Care is committed to treating and using your personal health information responsibly. This notice describes the information we collect, how and when we use or disclose that information, and your rights as they relate to your protected health information.

Understanding Your Personal Health Information
Each time you visit Physicians Immediate Care, a record of your visit is made which typically contains your symptoms, examination and test results, diagnoses, treatment, and referral information. This medical record may be used in some of the following ways:

To plan your care and treatment and to communicate to other health professionals who contribute to your care.
As a legal document describing the care you received
As a way for you or a third-party payer to verify that services billed were provided to you
As a tool in educating health professionals
As a source of data for medical research or public health officials As a source of data for our business planning, evaluation and marketing.

Understanding what is in your record and how your health information is used, helps you to be sure it is accurate, understand why others may access your health information, and make more informed decision when authorizing disclosure to others.

Your Health Information Rights
Although your health record is the physical property of Physicians Immediate Care, the information belongs to you. You have the right to:

Obtain a paper copy of this notice of information practices. Inspect and copy your health record as provided for in 45 CFR164.524.
Amend your health record as provided in 45 CFR 164.528.
Obtain an accounting of disclosures of your health information as provided in 45
CFR 164.528.
Request communication of your health information by alternative means or at alternative locations.
Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522.
Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Physicians Immediate Care's Responsibilities

Maintain the privacy of your health information.
Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
Abide by the terms of this notice Notify you if we are unable to agree to a requested restriction.
Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain.
We will not use or disclose your health information without your authorization, except as described in this notice.

If you have questions and would like additional information, you may contact Physicians Immediate Care's Privacy Officer (772) 343-1774.

If you believe your privacy rights have been violated, you can file a complaint with the HIPAA Officer or with the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201.

Release of Medical Records
If you would like to request copies of your medical records please print and complete the form and return it to any Physicians Immediate Care Urgent Care Center. Copies of your records will be provided to your designated person within 24 hours.

Medical Release Authorization Form